Background: One of the emerging areas of facial implant augmentation is that of the jaw angles. While jaw angle implants have been around for nearly two decades, their designs have been exclusively made for increasing jaw angle width. While there are some patients who seek a wider and more flared posterior jawline, a width only approach to the jaw angle in many patients will often lead to just a ‘fat’ jaw angle and a dissatisfied patient.
In today’s aesthetic standards, a strong and well defined jawline is a key male feature. This is not really new as strong jawlines have defined masculinity through the ages. What is new is that it is now more possible to create them than ever before by taking a multidimensional approach to their shape change. The development of new and improved chin styles for the front of the jawline have led to to new styles of jaw angle implants for the back of the jawline which incorporate more than just a simple width increase.
Many underdeveloped lower jaws have a classic jaw angle shape. Rather than being an L-shape with a 90 degree angle at the union of the vertical and horizontal rami, a weakly shaped jaw angle as part of a short overall developed jaw is seen. Thus many weak jaw angles have a high and widely angled shape. (greater than 110 degrees) In creating better jaw angle definition, vertical lengthening or elongation of the jaw angles is needed. They must be dropped and the jaw angle shape change to closer to 95 degrees.
Case Study: This 28 year-old male wanted to improve the shape of his jawline. He had adequate chin projection from a prior chin implant procedure but lacked any jaw angle shape. His jaw angles were high and very obliquely shaped. He wanted lower and more defined jaw angles but not necessarily a much wider jaw angle width.
Using a 3D CT scan, a mandibular (jaw) model was created. Off of this model, custom silicone jaw angle implants were made that dropped his angles down by 15mms but only added 3mms in width. The jaw angles on the implants were made much sharper at just about 90 degrees with more defined angle points.
Under general anesthesia, an intraoral approach using posterior lateral vestibular incisions was used. The bony jaw angles were exposed subperiosteally from the angle point anteriorly to just behind the mental nerve. The tendon over the angle point was released to allow the implant to really drop down the angle area. The silicone jaw angle implants were slide into place and secured into their position with a single 1.5mm titanium screw placed through a percutaneous technique. The incisions over the implants were closed in two layers including a muscle layer directly over the implants.
His recovery was very typical for jaw angle implants. It took a full three weeks for most of the swelling to subside and full mouth opening to return. His after results show considerable jaw angle shape improvement and definition with some slight jaw angle asymmetry. (due to a pre-existing soft tissue asymmetry)
Case Highlights:
1) Jaw angle augmentation must take into consideration the vertical length of the jaw angle and not just its width.
2) Jaw angle deficiences almost always have a high bony angle due to undergrowth of the vertical component of the mandibular ramus.
3) Vertical lengthening jaw angle implants can drop down the angle region while adding little width.
Dr. Barry Eppley
Indianapolis, Indiana